Santa Fe New Mexican
New Mexico has options for addressing its health provider shortage. Since a 2013 analysis of the state’s health care workforce, lawmakers have appropriated more than $36 million toward boosting provider numbers.
Each year, the Legislative Finance Committee analyzes the state’s health care workforce and makes recommendations on how to fill the gaps.
Since 2013, the state has done the following based on those recommendations:
• Increased the number of colleges offering Bachelors of Science in nursing to six from two to meet the increased need for nurses. By 2018, the state will offer BSNs at 17 nursing programs across the state. Nurses with bachelor’s degrees can help provide more primary care in rural and underserved areas at a fraction of the training cost required for primary care doctors. The state also increased the number of nursing education slots open to students.
Lorie MacIver, president of the hospital workers union, said increasing the number of nurses soon is a good idea. It would be ideal to place new nurses with experienced nurses in any hospital setting before the veteran nurses retire, she said.
• Expanded the training programs and the number of openings for nurse practitioners and physician assistants. These advanced practice nurses are less expensive to train and pay, and are qualified to handle most primary care needs for patients. Half the population is relatively healthy and only requires preventive care, such as vaccinations and periodic treatment for acute illnesses, so nurse practitioners and physician assistants are an economical means to meet needs in rural areas, according to studies.
• Expanded graduate medical residencies in primary care. All doctors must complete residencies before practicing. Doctors tend to stay where they complete residencies, according to an analysis by the Legislative Finance Committee. But the number of graduating physicians outpaced the number of available residencies, which are paid through Medicare. State lawmakers have worked with The University of New Mexico Health Sciences Center to expand residencies in primary care by nine a year for the next seven years.
Keeping the program going will require ongoing investments by the Legislature, and residencies aren’t cheap. Each residency costs about $150,000, according to the LFC.
• Increased funding for medical loan repayment programs. The LFC and a national study found that offering to repay the medical loans of doctors and other health providers after they work for two years in a rural area was more effective than offering scholarships to medical students who commit to working in underserved places. The scholarship students defaulted on their agreements more frequently.
But the loan repayment program could use a lot more funding — 89 percent of applicants did not receive money.
• In its 2015 report, the LFC urged the New Mexico Medical Board to review the scope of practice for physician assistants and to allow them to practice independent of a doctor’s oversight. It can be easier for rural hospitals and clinics to recruit physician assistants than to recruit primary care doctors.
• Funded expanded “pipeline” programs to introduce middle school and high school students in rural areas to health care professions and opportunities. Studies show health care providers from rural areas are more willing to practice in rural locations.
• Provided a $3,000 to $5,000 tax credit to health providers who work in rural and underserved areas. For 2015, 1,763 rural providers qualified for the credit, according to the state Department of Health.
The UNM Health Sciences Center has recommended extending the tax credit to pharmacists, counselors and social workers in rural areas.
• Established a 16-member task force to prepare a bill that will allow dental therapists to serve areas that lack dental services. It took four legislative sessions to pass a memorial in 2015 creating the task force. In New Mexico, 32 of 33 counties are federally designated as lacking dental health services. The state also increased funding to help students attend dental schools out of state, since New Mexico lacks a program.
• Offered state funding for a UNM service called Locum Tenens, which provides temporary doctors and nurses for rural hospitals and clinics that face a sudden shortage of providers, and another program through the Department of Health called NurseAdvice NM, which connects people by phone or online to veteran nurses.
• UNM’s Office of Community Health launched health extension offices in several rural locations around the state. These are based on the same educational model used for decades by the U.S. Department of Agriculture’s agriculture extension offices. Hidalgo Medical Services is one of the Health Extension Rural Offices.
While the programs are good, experts say, they can only go so far.
It will also be up to rural New Mexico communities to figure out how they can entice health care providers to their towns and keep them there.